目的 评估控制营养状态（CONUT）评分、血清CYFRA21⁃1表达与非小细胞肺癌（NSCLC）患者预后的关系，以及二者联合 分析在 NSCLC患者中的预后价值。方法 回顾性分析自2015年2月至2019年3月在南京鼓楼医院集团宿迁医院行手术治疗的168 例NSCLC患者的临床病理资料及随访数据，根据受试者工作操作特征曲线（ROC曲线）确定血清CYFRA21⁃1表达预测NSCLC患者 总生存（OS）率的最佳临界值。通过Kaplan⁃Meier 曲线及多因素Cox回归分析评估CONUT评分与血清CYFRA21⁃1表达在NSCLC患 者预后预测中的应用价值。结果 基于血清CYFRA21⁃1表达的临界值(4.05 ng/ml), 将所有NSCLC患者分为CYFRA21⁃1高表达(≥4.05 ng/ml, n=99)与低表达组(<4.05 ng/ml, n=69)。血清CYFRA21⁃1表达预测患者预后的曲线下面积(AUC)值为0.661 (95%CI=0.553~0.770)， 敏感度为78.1%，特异度为58.9%。Kaplan⁃Meier曲线展示CYFRA21⁃1高表达与低表达者的3年OS率分别为78.7%和90.5%，差异 有统计学意义(χ２= 5.966, P=0.015)，血清CYFRA21⁃1高表达提示患者预后不佳。此外，高CONUT评分与NSCLC患者不良预后相关， CONUT<2分与CONUT≥2分者的3年OS率分别为88.4%和76.6%，差异有统计学意义 (χ２= 7.526, P=0.006)。与其他患者相比，CONUT ≥2分且血清CYFRA21⁃1高表达者预后最差。单、多因素Cox分析的结果表明T分期(HR=2.382; 95%CI=1.141~4.969, P=0.021)、淋巴 结转移(HR=2.451; 95%CI=1.206~4.982, P=0.013)、CONUT评分(HR=2.636, 95%CI=1.301~5.344, P=0.007)及血清CYFRA21⁃1表达水 平(HR=2.481; 95%CI= 1.071~5.748, P=0.034)是NSCLC患者的独立预后因素。基于以上因素，构建一个非小细胞肺癌患者的列线图 预后预测模型，该模型的C⁃指数为0.768(95%CI=0.678~0.859)。结论 术前CONUT评分与血清CYFRA21⁃1表达水平是NSCLC患者 的独立预后因素，二者的联合分析或许能够为患者的预后评估及个体化治疗提供有价值的参考。

Objective To evaluate the relationships between controlling nutritional status (CONUT), serum expression level of CYFRA21⁃1 and the prognosis of non⁃small cell lung cancer (NSCLC) patients, and to explore the prognostic value of their combination for these patients. Methods The clinicopathological features and follow⁃up data of 168 NSCLC patients who received surgical resection from February 2015 to March 2019 were retrospectively analyzed from Suqian Hospital. The optimal cut⁃off point of serum CYFRA21⁃1 expression for the prediction of overall survival (OS) rate was determined by the receiver operation characteristics curve (ROC curve). Kaplan⁃Meier curve and Cox multivariate regression analysis were used to evaluate the prognostic value of CONUT score and serum CYFRA21⁃1 expression for NSCLC patients. Results All patients were divided into high expression (≥4.05 ng/ml, n=99) and low expression group (<4.05 ng/ml, n=69) based on the cut⁃off value of serum expression level of CYFRA21⁃1. The area under curve (AUC) value of serum CYFRA21⁃1 expression for predicting the OS of NSCLC patients was 0.661 (95%CI=0.553-0.770), the sensitivity and specificity was 78.1% and 58.9%, respectively. Kaplan⁃Meier curves showed that the 3⁃year OS of patients with high and low CYFRA21⁃1 expression was 78.7% and 90.5%, with a significantly statistical difference ( χ２=5.966, P=0.015). High expression of CYFRA21⁃1 was an indicator of poor survival in NSCLC patients. Moreover, high CONUT was associated with poor prognosis of NSCLC patients. The 3⁃year OS of patients with CONUT <2 and CONUT≥2 points were 88.4% and 76.6%, respectively(χ２= 7.526, P=0.006). Compared with other patients, those with CONUT≥ 2 points and high CYFRA21⁃1 expression had the poorest prognosis. The results of the univariate and multivariate Cox analysis demonstrated that T stage (HR=2.382, 95%CI= 1.141-4.969, P=0.021), lymph node metastasis (HR=2.451, 95%CI=1.206-4.982, P=0.013), CONUT (HR=2.636, 95%CI=1.301-5.344, P=0.007) and serum CYFRA21⁃1 expression (HR=2.481, 95%CI=1.071-5.748, P=0.034) were independent prognostic factors for NSCLC patients. Based on the above these factors, a nomogram model for prognostic prediction of NSCLC patients was constructed, and the C⁃index of the model was 0.768 (95%CI=0.678-0.859). Conclusion Preoperative CONUT and serum expression level of CYFRA21⁃1 were independent predictors of poor OS in NSCLC patients, and their combination analysis might provide useful information for prognostic assessment and individualized treatment of NSCLC patients